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• W4319461262 abstract "Routine hysteroscopic evaluation prior to assisted reproductive technologies (ART) is a novel approach with the potential to reduce ART failure even in the absence of evidence of uterine pathology. Following the publication of several relatively high-quality trials on this topic, we sought out to determine if this practice is beneficial. We searched Web of Science, Medline, PubMed, SCOPUS, Cochrane Library, and ClinicalTrials.Com from each database's inception until May 31st 2022 with our search strategy, attempting to locate all RCTs assessing the use of hysteroscopy in otherwise asymptomatic women undergoing ART. We included only RCTs that included at least one of our selected outcomes, and we excluded any studies with suspicion of pathology prior to time of hysteroscopy, other than knowledge of the patient's infertility. We included all the aforementioned studies regardless of procedures or modifications performed as a result of hysteroscopic findings. Our initial search yielded 1802 results, which reduced to 1421 after removal of duplicates. Ultimately 11 studies were found to meet our criteria and were included in our quantitative synthesis. We used Review Manager Software version 5.4.1 to analyze the data, which we imported after manually gathering from the 11 studies. Continuous and dichotomous outcomes were imported as standard deviations (SD). Pooled analysis was described as a mean difference, relative to 95 % confidence interval (CI) in cases of continuous data. Dichotomous outcomes were analyzed using a risk ratio (RR) and a 95% confidence interval. In homogeneous outcomes we used a fixed-effect model, and in heterogeneous outcomes we used a random-effect model. Our results showed that hysteroscopy was associated with significant improvement in the clinical pregnancy rate (RR=1.27[1.11,1.45],(P< 0.001)). We found no differences in the between the hysteroscopy group and the control group regarding the live birth rate (RR=1.26[0.99,1.59],(P = 0.06)), miscarriage rate (RR=0.99[0.81,1.19],(P=0.88)), fertilization rate (RR= 1.01[0.93,1.09],(P = 0.88)), incidence of multiple gestations (RR=1.29[0.98,1.71],(P = 0.07)), number of embryos transferred (MD=0.04[-0.18,0.26],(P = 0.73)), chemical pregnancy rate (RR=1.01[0.86,1.17],(P = 0.93)), and number of oocytes retrieved (MD= 0.44[-0.11,0.98],(P = 0.11)). We saw an improvement in the clinical pregnancy rate, but no significant improvement in the live birth rate with routine hysteroscopy prior to ART. We believe this does not represent sufficient evidence to recommend routine hysteroscopy for otherwise asymptomatic patients prior to ART at this time." @default.
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• W4319461262 date "2023-05-01" @default.
• W4319461262 modified "2023-10-14" @default.
• W4319461262 title "Effect of the decision to perform hysteroscopy on asymptomatic patients before undergoing assisted reproduction technologies—a systematic review and meta-analysis" @default.
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• W4319461262 doi "https://doi.org/10.1016/j.xagr.2023.100178" @default.
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